title: Which surgical procedure offers the best treatment for pilonidal disease?
abstract: OBJECTIVE
  Our aim was to determine the most effective surgical procedure for treatment of pilonidal disease, by comparing different surgical techniques.
  
  
  METHODS
  A total of 354 patients who underwent operation for pilonidal disease were enrolled in this prospective study. The data included patient's demographic characteristics, age, gender, body mass index, occupation, smoking, concomitant diseases, surgeon's experience, wound-healing problems (wound separation and infection), time to return to work, and development of recurrence.
  
  
  RESULTS
  Of the 354 patients, total excision + primary closure was performed in 133 (37.6%), D-flap in 101 (28.5%), Karydakis technique in 74 (20.9%), and Limberg flap surgery in 46 (13%). The male/female ratio was 8.5:1, which is a statistically significant difference (p < 0.05). The average follow-up period was 37 months (range, 12-97 months); during this period, wound-healing problems were observed in 70 (19.7%) patients, and 34 (9.6%) patients developed recurrence. There was no difference in the rate of recurrence of pilonidial disease between procedures done by trainees and staff surgeons. Recurrence rates were similar for all four treatment methods (7.5-13.5%). Wound-healing problems were higher for D-flap than for other methods (p = 0.027). The average time to return to work with the D-flap method was longer than that for the other methods (p < 0.01). Recurrence increased 14.44-fold following the development of wound infection. Higher recurrence rates were also noted in obese patients (8.10-fold) and in females (6.72-fold).
  
  
  CONCLUSIONS
  Despite the increasing volume of data on the treatment of pilonidal disease, the optimal treatment has yet to be established.
authors.affiliation: General Surgery, Ankara Numune Teaching and Research Hospital, 3, Kizilirmak mah. 1443. cadde No:35/10 Çankaya, 06510, Ankara, Turkey.
authors.forename: Bariş
authors.initials: B
authors.lastname: Saylam
authors.forename: Derya Nurhan
authors.initials: DN
authors.lastname: Balli
authors.forename: Arife Polat
authors.initials: AP
authors.lastname: Düzgün
authors.forename: M Vasfi
authors.initials: MV
authors.lastname: Ozer
authors.forename: Faruk
authors.initials: F
authors.lastname: Coşkun
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010864:Pilonidal Sinus / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D055502:Secondary Prevention; D018582:Sick Leave; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult